Immediacy is the key to boost teen adherence
Link preventive therapy to daily routines
When it comes to preventive therapy and the issue of compliance, adolescents are not exactly at the head of the class, experts say.
"I don't have the data to back this up, but it's my sense that high school and college-aged kids are at the worst ages for preventive therapy," says Patricia Simone, MD, chief of the field services branch of the of the Centers for Disease Control and Prevention's Division of Tuberculosis Elimination in Atlanta.
In fact, compliance is an issue in just about every sphere of adolescent medicine you can think of, says Anju Sikand, MD, assistant professor of pediatrics in the Division of Adolescent Medicine at the Children's Hospital of Michigan in Detroit.
It matters little whether the subject is getting pregnant, getting a sexually transmitted disease, being injured in a car accident, or coming down with TB, Sikand adds. "Often, teens have this sense of invulnerability and immortality," she says. "They tell themselves, `I'm not gonna be the one. This isn't going to happen to me.'"
Plus, Sikand adds, teens tend to think only about the present. That means it's tough for them to see the benefits of something as vague and future-oriented as preventive medicine. Such things as lung cancer and TB, the typical teen reasons, happen only to old people.
Even though they need close monitoring and follow-up, teens rarely get it, partly because of their tendency to resist directions from elders, and partly because they often look and act more grown up than they are, she says.
One way to increase adherence is to acknowledge teen-age tendencies and take advantage of them, Sikand says: "You've got to bring it down to, `How does it affect them today?'" For example, a teenager who loves to play sports is likely to be receptive to messages about how TB would spell a quick end to long afternoons playing basketball or soccer.
Sikand also tries hard to stay in touch with her teen-age patients. "I touch base with them often, especially in the beginning. I call them to make sure they're taking the pills; I stress that no matter what, they need to keep taking the pills. If they have a problem, they need to call me."
Give focused, written instructions
Giving focused, specific directions is helpful, too, she says. "I try to make sure they understand exactly what it is they're taking, and what it's for. I write everything down on a piece of paper. I try to be as specific as possible."
Being specific means, again, tying adherence to a teen-ager's daily activities. Keep your medication with your makeup, so you'll remember to take it every day, Sikand may tell female patients. "You have to spend some time listening and finding out how these kids spend their days," she adds.
She also tries to include parents but takes care to direct her instructions to the teens, not their moms or dads, especially when it comes to older kids. "You want to send the message that they're old enough to begin taking responsibility for their own lives and for their own health," she says. "That's already a big issue for teens, and sending that message helps empower them. They view this as something they can do for themselves."
One final note: Be available. When teens have a question or a problem, they usually won't call twice. "If they have a question, they tend to want it answered right away," Sikand says. "Because by the next day, whatever it was, it's gone. They're onto the next thing."
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